[I]t's just as important to be a smart consumer [about supplements] as it
is with traditional medicine.

Whenever a vitamin or supplement is powerful enough to heal, it also has
the power to harm if misused.

A varied, healthy diet is your best source of vitamins.

Evaluating Supplements, Herbs and Vitamins

The following excerpt is taken from Chapter
6
of Bipolar Disorders: A Guide to Helping Children and Adolescents
by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For
book orders/information, call (800) 998-9938. Permission is granted to
print and distribute this excerpt for noncommercial use as long as the
above source is included. The information in this article is meant to
educate and should not be used as an alternative for professional medical
care.

Once upon a time, only the health nuts crowed about the virtues of herbs
from the Peruvian rain forest or multivitamin bars. Now soft drinks are
spiked with St. John's wort and gingko biloba, and One-a-Day vitamins share
a shelf with a One-a-Day herbal mood supporter.

My mom is always sending me articles she clips out of magazines about
herbal remedies and how vitamins can cure everything. I'm curious, but
nervous. I actually bought some grapeseed oil, but I still haven't opened
it. I make sure [my daughter] takes her vitamins and that's about it. Maybe
someday I'll try the grapeseed oil and see if it helps. At least it should
be safer than some of the things she has been given by her doctor!
--Estella, mother of 8-year-old Selena (diagnosed bipolar II
disorder)

Although the glossy, new veneer of today's supplements may make them
look attractive, it's just as important to be a smart consumer in this area
as it is with traditional medicine. Being well-informed can be more
difficult, however. Medications with approval from the FDA or similar
government bodies undergo rigorous testing. Study results and detailed
information about these compounds are available in numerous books, online,
or directly from the manufacturers.

With supplements, that's not always the case. It seems like every week
another paperback book appears making wild claims for a new antioxidant
compound or herbal medication. These books--not to mention magazine
articles, web sites, and semi-informed friends--sometimes wrap conjecture
up in a thin veneer of science. They may reference studies that are
misinterpreted, that appeared in disreputable journals, or that were so
poorly designed or biased that no journal would publish them.

Supplement salespeople, and particularly those who take part in
multilevel marketing schemes, seem to have taken lessons from their
predecessors in the days of the traveling medicine show. They have little
to lose by making outrageous claims for their products, and much to gain
financially. Here are just a few of the unsupported claims found in a
single five-minute sweep of supplement-sales sites on the Internet:

"Soybean lecithin has been found to clean out veins and
arteries--dissolve the gooey sludge cholesterol--and thus increase
circulation, relieve heart, vein and artery problems. It has cured many
diabetics--cured brain clots, strokes, paralyzed legs, hands and
arms!"

Take the time to browse your local store's shelves, and you'll probably
spot a number of dubious products. Some companies try to deceive you with
sound-alike names, packaging that mimics other products, or suggestive
names that hint at cures. Other colorful bottles of pills contain
substances that can't actually be absorbed by the body in oral form--for
example, "DNA" (deoxyribonucleic acid, the building block of
human genetic material) graces the shelves of some shops. One manufacturer
of this useless "supplement" claims that "it is the key
element in the reprogramming and stimulation of lazy cells to avoid,
improve, or correct problems in the respiratory, digestive, nervous, or
glandular systems." This company notes that its "DNA" is
extracted from fetal cells; other brands are apparently nothing but
capsules of brewer's yeast.

Some other supplements provide end products of internal procedures, such
as glutathione, instead of the precursors needed for the body to make a
sufficient supply on its own, such as vitamin E. This approach may not
work. When in doubt, consult with your doctor or a competent
nutritionist.

How can you assess supplement claims? Start by relying primarily on
reputable reference books for your basic information, rather than on
advertisements or the popular press. Watch out for any product whose
salespeople claim it will cure anything. Supplements and vitamins may
enhance health and promote wellness, but they rarely effect cures. Be wary
of universal usefulness claims. The worst offenders in supplement
advertising tout their wares as cure-alls for a multitude of unrelated
conditions.

There are a few other sales pitches that should make you wary. If a
product's literature references the myth of the long-lived Hunzas,
someone's trying to pull the wool over your eyes. This tale of hardy
Russian mountain folk who supposedly all live to be well over one hundred
years old was refuted long ago by reputable researchers. If it's a natural
substance but a particular company claims to be the only one to know the
secret of its usefulness, that really doesn't make much sense. Be
especially cautious when sales pitches are written in pseudoscientific
language that doesn't hold up under close examination with a dictionary.
This is a popular ploy. For example, one supplement sold by multilevel
marketers claims to "support cellular communication through a dietary
supplement of monosaccharides needed for glycoconjugate synthesis."
Translated into plain English, this product is a sugar pill.

Even when you have seen the science behind a vitamin or supplement
treatment, there's still the problem of quality and purity. It's almost
impossible for consumers to know for sure that a tablet or powder contains
the substances advertised at the strength and purity promised. Whenever
possible, do business with reputable manufacturers that back up their
products with potency guarantees or standards. In many European countries,
potency is governed by government standards; in the US, it's a matter of
corporate choice.

Natural does not mean harmless. Whenever a vitamin or supplement is
powerful enough to heal, it also has the power to harm if misused. Be sure
to work closely with your physician or a nutritionist if your child will be
taking anything more complex than a daily multivitamin.

Many herbs have been used to treat neurological disorders through the
ages. Herbalists call these substances nervines, and some may prove useful
for treating specific symptoms of bipolar disorders.

Of all the herbal remedies, this group of plant extracts are among the
strongest, and the most likely to cause serious side effects. Along with
the herbal sleep aids mentioned earlier in this chapter, nervines that have
been tried by people with bipolar disorders or related conditions
include:

Black cohosh (Cimicifuga racemosa). A nervous system depressant
and sedative, sometimes used by people with autoimmune conditions for its
anti-inflammatory effects. Its active ingredient appears to bind to
estrogen receptor sites, so it may cause hormonal activity.

Damiana (Turnera aphrodisiaca). A traditional remedy for
depression. As its Latin name indicates, it is also believed to have
aphrodisiac properties. Whatever the case may be there, it does seem to act
on the hormonal system. Its energizing quality might be dangerous for
bipolar patients.

Gingko biloba. An extract of the gingko tree, advertised as an
herb that can improve your memory. There is some clinical evidence for this
claim. It is an antioxidant, and is prescribed in Germany for treatment of
dementia. It is believed to increase blood flow to the brain.

Ginseng (Panax quinquefolium). Has an energizing effect that may
be helpful to people whose depression is accompanied by extreme fatigue and
lethargy.

Grapeseed oil and pycogenol. Both are extra-powerful
antioxidants. (Pycogenol is derived from marine pine trees.)

Sarsaparilla (Hemidesmus indicus). Like licorice, it seems to
affect hormone production as well as settling the stomach and calming the
nerves.

St. John's Wort (Hypericum perforatum). Has gained popularity as
an herbal antidepressant. It has the backing of a decent amount of
research. Those choosing to use this remedy should follow the same
precautions as with SSRIs and MAOIs, two families of pharmaceutical
antidepressants. It can also cause increased sensitivity to light. It is
available by prescription in Germany, where it is the most widely used
antidepressant. It is potentially dangerous to use St. John's Wort with
prescription antidepressants or any other medication that could affect
serotonin.

The only herbal remedy I tried was St. Johns Wort, and I saw no improvement
in my mood. --Stephanie, age 32 (diagnosed with bipolar disorder at age 15
and now the mother of a bipolar child)

A varied, healthy diet is your best source of vitamins. Some researchers
believe that people with bipolar disorders may metabolize certain vitamins
differently, and therefore require either careful intake via food or
supplementation.

If you plan to pursue vitamin therapies, purchase a basic guide to
vitamins and minerals that includes information about toxicity symptoms.
Some people metabolize vitamins and minerals differently, and may be more
or less susceptible to potential toxic effects. Along with your doctor's
guidance, a good reference book can help you avoid problems.

Also, take vitamin company sales pitches and dosage recommendations with
a grain of salt. The testimonials these companies produce are intended to
sell their products, not to help you develop a treatment plan. Consult a
physician or a professional nutritionist who does not sell supplements for
unbiased, individualized advice.

Vitamins often cited as important in mood regulation include the B
vitamins. If you are deficient in any of the Bs, depression, anxiety, and
fatigue can result. The B vitamins work together, so it's best to take a
B-complex supplement that mixes them in proper proportions along with folic
acid. The Bs have a generally energizing effect and help build up the
immune system. Some alternative practitioners recommend vitamin B-12 shots
for depressed patients. They don't always work, but sometimes they can have
surprisingly quick mood-elevating effects. Because of that energizing
effect, however, they may not be a good idea for those who are hypomanic or
manic. B vitamins are used up more quickly when the body or mind is
stressed, so supplementing during these times could have a preventive
effect. A list of B vitamins follows:

Vitamin B-1 (Thiamin). Alone, or in addition to a regular
B-complex pill, B-1 might be a good idea for bipolar patients who suffer
from circulation problems, tingling in the extremities, anxiety,
irritability, night terrors, and similar symptoms.

Vitamin B-6 (Pyridoxine). In addition to a regular B-complex
pill, B-6 might be indicated for bipolar patients who present with a great
deal of irritability, and for those with marked premenstrual symptoms
and/or motion sickness. If you start to experience tingling in your hands
or feet, reduce or discontinue the B-6.

Vitamin B-12. Helps your body turn food into energy, and without
enough of it you are likely to feel listless and fatigued. Vegetarians may
also be deficient in B-12, as it's found mostly in meat.

Vitamin E. An antioxidant that also seems to reduce the
frequency of seizures in some people who have epilepsy. It's especially
important to take vitamin E if you take Depakote, Depakene, or another
anticonvulsant, as these drugs deplete vitamin E. If you have high blood
pressure, monitor it carefully after starting vitamin E, and reduce the
dose if your blood pressure rises.

Vitamins A and D are fat-soluble, so they are stored in the body's fat
cells for later use. Having a little socked away for a rainy day is
probably okay, but if you take too much, hypervitaminosis may develop.

Symptoms of hypervitaminosis A include orangeish, itchy skin; loss of
appetite; increased fatigue; and hard, painful swellings on the arms, legs,
or back of the head. Symptoms of hypervitaminosis D include hypercalcemia,
osteoporosis, and kidney problems.

Don't overdo it with any fat-soluble vitamin, and also be careful with
fish-oil supplements (and cod liver oil), which are high in both vitamins A
and D.

Folic acid can counteract the effects of Depakote, Depakene, and some
other anticonvulsants if taken in large amounts. It may also cause manic
mood swings.

Minerals are naturally occurring substances that are basic building
blocks for cells and chemical processes in the body. Most of them are
needed in relatively small amounts, amounts that are covered through the
combination of a reasonably decent diet and a regular multivitamin with
minerals.

Supplementing with specific minerals can be helpful for alleviating
bipolar symptoms, however. Minerals that are sometimes suggested
include:

Calcium. Important for the regulation of impulses in the nervous
system and for neurotransmitter production. If you supplement with
magnesium, you should also take twice that amount of calcium--these two
minerals need each other to work. However, excessive levels of calcium
(hypocalcinuria) can result in stupor.

Chromium picolinate. May help control the sugar and carbohydrate
cravings that many patients experience while taking Depakote or Depakene.
Chromium picolinate can act like a stimulant, however, so keep an eye out
for this side effect.

Magnesium. Lowers blood pressure, and is also important for the
regulation of impulses in the nervous system and neurotransmitter
production. Magnesium deficiency can cause anxiety and insomnia, and it can
also lower your seizure threshold. This mineral is rapidly depleted during
periods of stress, hard work, hot weather, or fever, and that's probably
one of the reasons that these conditions can precipitate a seizure. If you
are supplementing with vitamin B-6, you will need to add magnesium as
well.

Manganese. Deficiency is marked by fatigue, irritability, memory
problems, and ringing or other noises in the ears. It is needed in trace
amounts only, but some people's diets do not include enough.

Zinc. Another trace mineral that's often absent from the diet.
Symptoms of deficiency can include mental disturbance.

If it's not an herb, vitamin, or mineral, you can simply call it a
nutritional supplement. That means the manufacturer agrees not to market it
as a drug, and the FDA agrees to consider it a food. Meanwhile, consumers
are left unsure about whether these supplements provide nutrients (they
usually don't), cure disease (rarely, if ever), or simply promote
health.

The supplements category includes amino acids. There are 22 of these
simple compounds, which combine to create all of the body's proteins. Most
amino acids are produced by the body itself, but some people do report
benefits from taking amino acid supplements. These may combine several
amino acids, or include just one.

Along with the amino acids listed in the section "Other sleep
supplements" earlier in this chapter, supplements that may be
suggested for symptoms of bipolar disorders include:

Lecithin (phosphatidyl choline). A phospholipid found mostly in
high-fat foods. It is said to have the ability to improve memory and brain
processes. Lecithin is necessary for normal brain development; however,
double-blind studies of patients with Alzheimer's disease did not
substantiate claims that it can help people recover lost brain function.
The ketogenic diet increases the amount of lecithin in the body, which may
be one of the reasons for its success in some cases of hard-to-treat
epilepsy. Some people with epilepsy have also reported reducing their
number and severity of seizures from taking lecithin alone.

Some studies of lecithin-use by people with bipolar disorder indicate
that it can stabilize mood, while others indicate that it tends to depress
mood (and might therefore be more useful to a person who is manic or
hypomanic). It does not appear to cause harm, and there are some logical
reasons to think it might help--especially for patients who also have
seizures. Lecithin capsules are available, but many people prefer the soft
lecithin granules. These are a nice addition to fruit juice smoothies,
adding a thicker texture. Lecithin is oil-based, and it gets rancid easily.
It should be refrigerated.

Choline. One of the active ingredients in lecithin. It is needed
by the brain for processes related to memory, learning, and mental
alertness, as well as for the manufacture of cell membranes and the
neurotransmitter acetylcholine. Acetylcholine is involved in emotional
control and other regulatory functions. Its effectiveness for bipolar
symptoms is unknown.

Inositol. Another active ingredient in lecithin. It is required
by the neurotransmitters serotonin and acetylcholine, and may repair some
types of nerve damage. Clinical studies indicate that inositol supplements
may be helpful for some people with obsessive-compulsive disorder,
depression, and panic disorder. Its effectiveness for bipolar symptoms is
unknown.

Taurine. An amino acid that appears to have antiseizure
capabilities, and has gotten good reviews from some adults with bipolar
disorders. It inhibits abnormal electrical activity in the brain, and is
often found to be deficient in brain tissue where seizures have been
occurring. Interestingly, rapid cyclers report the best results.
Recommendations range from 500 to 1000 mg per day, divided into as many as
three doses. Experts recommend buying only pharmaceutical-quality L-taurine
from reputable manufacturers. Unusual EEG activity has been reported in
patients using doses over 1000 mg per day.

GABA. (gaba-amino butyric acid) An amino acid-like compound that
acts like a neurotransmitter by inhibiting other neurotransmitters. A
number of medications are under development that would affect GABA
production or usage; some existing drugs that affect GABA, such as
Gabapentin and Depakote, are used to treat manic depression. You should not
take these medications with GABA supplements unless your physician
recommends it and oversees the process. Supplementation with
over-the-counter GABA is sometimes recommended for anxiety, nervous
tension, and insomnia, especially insomnia associated with racing thoughts.
If you experience shortness of breath, or tingling or numbness in your
hands or feet when taking GABA, lower or discontinue this supplement.

Tyrosine. An amino acid that serves as a precursor to the
neurotransmitters norepinephrine and dopamine. It may help the body form
more of these neurotransmitters, and is also believed to provide support
for optimal thyroid gland function. Tyrosine can raise blood pressure, so
talk to your child's doctor about using it if your child takes other
medications that affect blood pressure.

Phenylalanine. An essential amino acid, as well as the precursor of
tyrosine. It has an indirect effect of boosting production of
norepinephrine and dopamine. Like tyrosine, phenylalanine can raise blood
pressure.

Methionine. An antioxidant amino acid that has been shown to be
helpful for some individuals suffering from depression. It has an
energizing effect--and as with SAME, below, that could precipitate mania in
bipolar patients.

SAME (S-adenosyl-methionine). A metabolite of methionine that is
used to treat depression and arthritis in Europe. It became available in
the US in early 1999. It is believed to affect dopamine and serotonin, and
to have anti-inflammatory effects. However, it is not recommended for
people with bipolar disorder, as it may cause mania.